Say, what?

Terri Sciavo was in no position to ask for her feeding tube to be left in.

Now we have a case where someone is in a position to ask, and he may not receive.

A man who is terminally ill and fears that doctors may allow him to die of thirst said he was "disappointed" yesterday after the Court of Appeal overturned an earlier judgment in his favour. Last July, the High Court granted a challenge by Leslie Burke, 45, and declared that key sections of General Medical Council guidance on withdrawal of life-prolonging treatment were unlawful. But yesterday three appeal judges allowed an appeal by the GMC against the ruling, setting aside six declarations by the trial judge. Permission to appeal was refused.

Burke suffers from a degenerative disease which will eventually kill him. Before that, it will take away his ability to swallow.

Lord Phillips explained that Mr Burke appeared to fear that ANH would be withdrawn before the final stages of his disease, when it would not be capable of prolonging his life. "If this is Mr Burke's fear, there is no reason for him to have it," Lord Phillips said.

Maybe – maybe – it's not as bad as it sounds. The ruling may be pretty narrowly worded:

The judges added that, "where a competent patient indicates his or her wish to be kept alive by the provision of ANH, any doctor who deliberately brings that patient's life to an end by discontinuing the supply of ANH will not merely be in breach of duty but guilty of murder". But they stressed that "in the last stage of life" ANH - far from prolonging life - may even hasten death. "It is only in this situation that, assuming the patient remains competent, a patient's expressed wish that ANH be continued might conflict with the doctor's view that this is not clinically indicated." Mr Justice Munby ruled in the High Court that the patient had the right to insist on ANH but the Court of Appeal disagreed. "A patient cannot demand that a doctor administer a treatment which the doctor considers is adverse to the patient's clinical needs. That said, we consider the scenario that we have just described is extremely unlikely to arise."

In effect, this seems to say that a patient has a right to be kept alive as long as possible. The problem arises when the patient and the doctor disagree over what steps will actually accomplish that end.

I guess this is another example where the situation isn't as black-and-white as the headlines would indicate.